British Journal of Cancer (2004) 91, 907 – 912
& 2004 Cancer Research UK All rights reserved 0007 – 0920/04 $30.00
www.bjcancer.com
E Grundy*,1, D Mayer1, H Young1 and A Sloggett1
1
Centre for Population Studies, Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, 49-51 Bedford
Square, London WC1B 3DP, UK
The main objectives of the study were to (1) see whether the household circumstances of people aged 50 years and over with
cancer, and trends in these, differ from those of the rest of the population and (2) whether living arrangements and presence and
health status of a primary coresident are associated with place of death among older people dying of cancer and those dying from
other causes. The design included prospective record linkage study of people aged 50 years and over included in a 1% sample of the
population of England and Wales (the Office for National Statistics Longitudinal Study). The main outcome measures comprised
family and household type, and death at home. The household circumstances of older people with cancer were very similar to those
of the rest of the population of the same age and both showed a large increase in living alone, and decrease in living with relatives,
between 1981 and 1991. The primary coresident of cancer sufferers who did not live alone was in most cases a spouse, with much
smaller proportions living with a child, sibling or other person. In all, 30% of spouse, and 23% of other, primary coresidents had a
limiting long-term illness. Compared with people who lived alone in 1991, odds of a home death among those dying of cancer
between 1991 and 1995 were highest for those who lived with a spouse who had no limiting long-term illness (odds ratio (OR) 2.52,
95% confidence interval (CI) 2.15 – 2.97) and raised for those living with a spouse with a long-term illness (OR 2.14, CI 1.79 – 2.56)
and those living with someone else who was free of long-term illness (OR 2.13, CI 1.69 – 2.68). Higher socioeconomic status, both
individual and area, was positively associated with increased chance of a home death, while older age reduced the chance of dying at
home. The changing living arrangements of older people have important implications for planning and provision of care and treatment
for cancer sufferers.
British Journal of Cancer (2004) 91, 907 – 912. doi:10.1038/sj.bjc.6602038 www.bjcancer.com
Published online 13 July 2004
& 2004 Cancer Research UK
Keywords: palliative care; cancer; place of death; older people; longitudinal; household and family
Cancer is a predominant cause of death and in 2001 accounted for
26% of all deaths in England and Wales, compared with 20%
attributable to ischaemic heart disease (Office for National
Statistics, 2002). In older age groups, even higher proportions of
deaths are due to cancer. Improvements in cancer survival,
increases in the incidence of some cancers and the ageing of the
population also mean that the prevalence of cancer in the
population has increased, so there are both more people living
with cancer and more people dying from cancer than in the past.
In this context, the support of older people with cancer including
support to die at home if they wish for those with terminal
conditions, is becoming an increasingly important issue for health
providers and policy makers. It has recently been suggested, for
example, that if more cancer patients were enabled to die at home,
the UK National Health Service could make savings of d100 m
every year (Burke, 2004). However, information on relevant
parameters, such as with whom people with cancer live, is very
limited. Here, we investigate the living arrangements of older
*Correspondence: Professor E Grundy; E-mail: emily.grundy@lshtm.ac.uk
Received 23 February 2004; revised 7 June 2004; accepted 9 June 2004;
published online 13 July 2004
people, and characteristics of those they live with, and see whether
these are associated with chance of a home death.
Coresidents are potential providers of emotional support,
domestic help and personal and nursing care for people with
cancer, although ability and willingness to provide these supports
may depend on characteristics such as health status, age and
relationship to the cancer patient. Support from a coresident may
influence both the quality of life of cancer sufferers and their need
for external services, including in-patient admission. Studies of
particular patient groups from a range of settings have reported
that cancer patients who live alone report more distress, poorer
adjustment to diagnosis and have a poorer quality of life than
those living with others (Forsberg and Cedermark, 1996; Akechi
et al, 1998; Rustoen et al, 1999; Sollner et al, 1999; Sarna et al,
2002). Living arrangements may also influence chance of a home
death, for which many people with cancer report a preference
(Davison et al, 2001; Serra-Prat, Gallo and Picaza, 2001). Local
studies of particular patient groups in the UK suggest that people
dying from cancer are more likely to be admitted for terminal care
if they live alone (Hinton, 1994); similar studies from Belfast, Italy
and North America have reported that cancer patients living with a
spouse more often die at home (Costantini et al, 1993;
McWhinney, Bass and Orr, 1995; Davison et al, 2001; Gallo, Baker
and Bradley, 2001). Several studies have also reported an
Clinical
Living arrangements and place of death of older people with
cancer in England and Wales: a record linkage study
Living arrangements and place of death
E Grundy et al
908
Clinical
association between socioeconomic disadvantage and a reduced
chance of a home death, although some of these have only used
ecological indicators of socioeconomic status (Grande, AddingtonHall and Todd, 1998; Higginson et al, 1999).
In Britain and other industrialised countries, recent decades
have seen marked changes in the living arrangements of older
people, including large increases in the extent of solitary living and
declines in the proportion of people living with relatives other
than, or in addition to, a partner and never married children.
These changes have been greatest in very old age groups; between
1971 and 1991, for example, the proportion of women aged 85
years and over living in households including two or three
generations fell from 42 to 21%, whereas the proportion living
alone increased from 30 to 49% (Grundy, 1999). It is not known
whether trends in the living arrangements of people with cancer
have changed to the same extent or whether they differ from those
of the rest of the population of the same age. This might be the case
if, for example, older people responded to a cancer diagnosis
by moving in with relatives, or having a relative move in with
them, or if differentials in survival by household circumstances
influenced the distribution of the population with cancer by living
arrangement.
In this paper, we use data from a large, nationally representative
record linkage study, the Office for National Statistics Longitudinal
Study (ONS LS), to examine the living arrangements of people with
cancer, trends in these living arrangements, characteristics of
coresidents of cancer sufferers and associations between living
arrangements and death at home.
STUDY SAMPLE AND METHODS
The ONS LS includes information on census characteristics of
sample members, and those they live with, and cancer and death
registration data for approximately 1% of the population of
England and Wales. The sample size in the ONS LS has remained
constant at approximately 540 000 individuals since 1971
(Blackwell et al, 2003). The sample was initially drawn from
people enumerated in the 1971 Census and has been maintained
through the addition of 1% of immigrants and new births. The data
may be used both to look at trends over time (comparison of
cross-sectional data from successive censuses or deaths in
successive periods) and in longitudinal analyses of changes in
individual circumstances or length of survival. Linkage of cancer
registrations and deaths is achieved via the National Health Service
Central Register. Particularly in the age groups considered here,
estimated linkage rates are very high (close to 100%) and loss to
follow-up low (Hattersley and Creeser, 1995).
We first compare the family and household type of people aged
50 years and over with and without a registered cancer in 1981 and
1991 to see whether the distribution by living arrangements, and
trend in living arrangements, was similar for people with cancer
and the rest of the population. Sample members included in this
analysis were those aged 50 years and over at the relevant census
who had been members of the LS for the preceding decade. People
with cancer were defined as those with a malignant cancer
registered in the previous 10 years (1971 – 1981 or 1981 – 1991).
Cases with benign growths, in situ carcinomas and growths with
uncertain, unknown or wrongly coded behaviour (which occurs
when a site code is benign but behaviour is coded as malignant)
were excluded; these exclusions accounted for under 10% of cases.
In the fewer than 5% of cases where more than one cancer
registration was recorded, first occurring registration was selected.
The classification of household type was derived from census
information on families and households and has been used in
other analyses of living arrangements of older people (Grundy,
1999). We classified people as solitary; living just with a spouse
(couple only); with a spouse and others (generally children); those
British Journal of Cancer (2004) 91(5), 907 – 912
with no partner living with a never-married child (lone parent);
those in households we term ‘complex’ (people living with relatives
other than a spouse or never-married child, such as a married
child or a sibling, and those in households containing more than
one family, for example, a married couple, daughter and
daughter’s child); and those in communal establishments such as
hospitals or nursing homes. Analyses are restricted to those
permanently resident at the place of enumeration (98% of the ONS
LS sample).
Secondly, for those who were living with someone else in 1991,
we investigated characteristics of their primary coresident, which
might be associated with ability to provide care at home for a
cancer sufferer. Primary coresidents were selected using a
hierarchical algorithm in which spouses, adult children, parents,
siblings and other relatives were selected as the primary coresident
in turn. In cases where there was more than one person in a
particular category (for example, two adult children), we chose the
oldest, and in the very few cases where two were of the same age we
selected the woman, as being more likely to adopt a care-giving
role. We distinguish between spouse primary coresidents and
other primary coresidents and examine the distribution of each
category by broad age group, whether or not they had a limiting
long-standing illness and whether or not they had a full-time job.
We also determine whether there was another adult in the
household, who might be a potential support for both the person
with cancer and the primary co-resident, and whether the
household included a child under 18 years, who might present a
competing care need.
Finally, we analysed variations in the proportions of decedents,
1991 – 1995, who died at home by whether they lived alone or with
someone else in 1991; by health status of the coresident where
there was one; by socioeconomic status; and by whether underlying cause of death was coded as cancer or not. The socioeconomic indicators drawn from the census were housing tenure
(owner or renter) and whether electoral ward of residence fell into
the top three or bottom two quartiles of Carstairs’ index of
deprivation (Carstairs and Morris, 1989). Information on date,
place and cause of death (coded here using the ICD-9 classification
with three digit codes) is available from linked death registration
records. We calculated proportions of home deaths among LS
members who died between the 1991 Census and the end of 1995
by sociodemographic characteristics, coresident’s health and
employment status and whether underlying cause of death was
cancer. We then used logistic regression to analyse associations
between presence, type (spouse or other) and health status of
primary coresident with the proportion of decedents dying at
home, including in the models gender, age group and socioeconomic indicators. This analysis was carried out for cancer
deaths, noncancer deaths and all deaths combined in order to see
whether effects varied by whether or not cancer was the cause of
death.
RESULTS
Family and household circumstances of people with cancer
The 1981 sample analysed included 4238 people aged 50 years and
over, who had been diagnosed with cancer in the previous decade;
the equivalent 1991 sample of 6257 people was larger, reflecting the
increase in the size of the older population and in the prevalence of
cancer already referred to. Those living alone comprised 22.4 and
27.9%, respectively, of the 1981 and 1991 samples. As shown in
Table 1, living arrangements of people with cancer varied
considerably by age and gender. In both 1981 and 1991, over
80% of men with cancer aged 50 – 59 years lived with a spouse or a
spouse and others, and although the proportion living alone or in
complex types of family increased with age, even among those aged
& 2004 Cancer Research UK
Living arrangements and place of death
E Grundy et al
909
Table 1
Family/household type of people with a cancer diagnosis in the previous 10 years in 1981 and 1991
Census point and age group
1991(%)
50 – 59
60 – 69
70 – 79
80+
50 – 59
60 – 69
70 – 79
80+
Men
Solitary
Couple
Couple+others
Lone parent
Complex
Communal est.a
b
All ( ¼ 100%)
6.7
36.9
46.8
2.3
4.4
o1
344
9.1
60.9
20.6
2.3
6.7
o1
608
15.1
65.8
7.0
1.8
8.7
1.5
654
21.8
45.0
4.7
2.8
17.5
8.1
211
7.3
42.6
42.6
1.3
4.0
o1
399
14.3
60.7
17.8
0.8
4.7
1.1
859
17.8
66.0
7.9
1.6
3.8
2.6
1003
27.5
48.3
4.1
2.6
7.4
9.6
542
Women
Solitary
Couple
Couple+others
Lone parent
Complex
Communal est.a
b
All ( ¼ 100%)
9.3
43.7
35.6
4.7
4.2
o1
593
27.6
47.4
9.3
5.4
10.0
o1
703
41.3
33.3
4.9
5.8
11.0
3.8
773
45.2
10.2
1.4
9.1
22.4
11.7
352
12.9
44.8
30.2
6.7
4.1
o1
612
26.9
49.2
10.6
6.4
6.3
0.3
1011
46.7
34.1
4.2
4.2
7.4
3.2
1089
55.1
11.6
0.4
3.9
11.7
17.1
742
a
Some results rounded in order to comply with confidentiality requirements. bIncluding small numbers in categories not shown such as adult children living with parents.
80 years and over half lived with a spouse. Among women, the
proportions living alone were much higher and the proportions
living with a spouse much lower, as would be expected given
gender differences in marital status distributions in older age
groups. Among both men and women, the proportions living alone
were higher, and proportions living with a relative other than a
spouse lower, in 1991 than in 1981, especially in the oldest groups.
In 1991, only 7% of men aged 80 years and over with a cancer
registration lived in a complex household compared with 18% in
1981. A total of 55% of women aged 80 years and over who had
cancer lived alone in 1991 and only 16% in a household including a
relative other than, or in addition to, a spouse, compared with 45
and 33% respectively in 1981. These distributions and the
differences between 1981 and 1991 are close to those noted in
the whole population, and comparable data for the population
without a cancer registration showed virtually no differences
between those with and those without cancer (see appendix).
Primary coresidents of people with cancer in 1991 (Table 2)
For the 4235 sample members who were living with someone else
in 1991, we analysed characteristics of their primary coresidents.
Most of this group (86%) lived with a spouse. The remaining 582
individuals had another primary coresident; 58% of these were
adult children, 5% were parents, 12% siblings and 25% other
relatives or unrelated persons. In most cases (78%), the LS member
with cancer lived with one other person only and the small
proportion in households including another adult decreased with
age.
There was a strong association between the age group of the
cancer sufferer and the age group of their spouses (l2 ¼ 76.79,
Po0.0001). Thus, 78% of wives of men with cancer aged 80 years
or more were themselves aged 75 years or more. Husbands of
women aged 80 years and over with cancer were even more likely
to themselves be aged at least 75 years. Related to this, spouse
coresidents of the oldest LS members with cancer were the most
likely to have a limiting long-term illness. The smaller group of
non-spouse primary coresidents included a much lower proportion aged 75 years or over, not surprisingly given that many of
these coresidents were children of the person with cancer. Even so,
23% of these other primary coresidents had a limiting long& 2004 Cancer Research UK
standing illness. Overall, 1237 primary coresidents (26%) had a
limiting long-term illness. However, this was no different from the
expected number (1350, 28%) calculated using age- and sexspecific rates of limiting long-term illness.
Living arrangements and death at home
Table 3 shows the proportion of home deaths among LS members
who died between the 1991 Census and the end of 1995 by
sociodemographic characteristics, coresident’s health and employment status and whether the underlying cause of death was cancer.
A total of 28% of those dying from cancer died at home, very
similar to the 26% reported for cancer deaths among people of all
ages in England in 1992 (Higginson et al, 1998). The proportion of
home deaths was lower among women than men, decreased with
age and was lower for those living alone than for those living with
someone else.
Table 4 presents results from regression analysis, showing odds
of death at home by primary coresident’s age and health
characteristics and socioeconomic indicators (other variables
shown in Table 3 were dropped as they proved nonsignificant).
Among those dying of cancer, odds of a home death were highest
(compared with the reference category of those living alone) for
those living with a spouse who had no long-term illness (odds ratio
(OR) 2.53, 95% confidence interval (CI) 2.15 – 2.97) and significantly raised for those living with a spouse who had a long-term
illness (OR 2.14, CI 1.79 – 2.56) or with another adult with no longterm illness (OR 2.13, CI 1.69 – 2.68). However, for those dying
from other causes, presence of a spouse with or without longstanding illness, or other primary coresident with a long-term
illness had no significant effect, and having as a primary coresident
someone other than a spouse with no long-term illness only a very
marginal one (OR 1.16, CI 1.02 – 1.32, Po0.05).
Results from the model also showed that among both those
dying from cancer and those dying from other causes, older age
was associated with reduced odds of a home death (even though
living arrangement was included in the model) as were indicators
of socioeconomic disadvantage. Those dying aged 70 – 79 or 80
years and over were much less likely to die at home than people in
their 50s or 60s; compared with the reference category of people
aged 50 – 59 years at death, people dying of cancer at ages 80 years
British Journal of Cancer (2004) 91(5), 907 – 912
Clinical
1981 (%)
Living arrangements and place of death
E Grundy et al
910
Table 2
Characteristics of primary coresidents of people with cancer, 1991
Age group and sex of person with cancer
Men (%)
Women (%)
50+
50 – 69
70 – 79
50+
80+
Characteristics of primary coresident
(% with stated characteristic)
Clinical
Aged o50 years
50 – 74 years
75+ years
Has long-term illness
Employed FT
No other adult in household
Child aged o18 years in household
N ( ¼ 100%)
Spouse primary coresident
11.7
o1
0
87.9
76.0
22.0
0.5
23.8
78.1
20.6
33.5
44.6
17.6
1.5
o1
71.2
89.1
91.6
8.4
1.6
1.1
1030
749
287
Male
Female
Aged o 50 years
50 – 74 years
75+ years
Has long-term illness
Employed FT
No other adult in household
Child aged o18 years in household
N ( ¼ 100%)
Other primary
36.2
63.8
41.4
31.0
27.6
27.6
20.7
67.2
17.2
58
coresident
43.8
56.3
45.8
37.5
16.7
41.7
33.3
75.0
10.4
48
38.0
62.0
30.0
56.0
14.0
18.0
38.0
52.0
12.0
50
50 – 69
70 – 79
%
N
5.9
74.4
19.7
28.6
9.4
80.5
4.9
2066
122
1537
407
591
194
1663
101
2066
2.2
94.3
3.5
27.4
37.5
74.1
5.4
1079
0
41.9
58.1
41.2
2.4
88.3
o1
420
39.1
60.9
39.1
41.0
19.9
28.9
30.1
64.7
13.5
156
61
95
61
64
31
45
47
101
21
156
52.7
47.3
76.6
14.9
8.5
14.9
52.1
78.2
16.5
188
51.6
48.4
49.2
30.7
20.2
22.6
41.1
71.8
5.7
124
80+
%
N
0
4.6
95.5
48.9
o4
95.5
0
88
1.5
75.4
23.1
32.3
26.2
79.0
3.8
1587
24
1197
366
512
416
1254
60
1587
46.5
53.5
23.7
52.6
23.7
29.0
36.8
57.0
8.8
114
51.6
48.4
49.2
30.7
20.2
22.6
41.1
71.8
5.7
426
216
210
232
126
68
89
191
301
48
426
Note: Some results are rounded to comply with confidentiality regulations of the Longitudinal Study.
Table 3 Proportion of decedents who died at home in 5-year period following 1991 Census for cancer compared to other deaths by individual and
household characteristics in 1991a
Cancer deaths
1991 characteristics
Male
Female
50 – 59 years
60 – 69 years
70 – 79 years
80+ years
Lives alone
Lives with spouse with no long-term
illness
Lives with spouse with long-term illness
Lives with other with no long-term
illness
Lives with other with long-term illness
Primary coresident employed FT
Primary coresident not employed FT
Other adult in household
No other adult in household
Child aged o18 years in household
No child o18 years in household
Owner occupier
Tenant
Carstairs quintile (1 – 3)
Carstairs quintile (4 – 5)
All
Other deaths
All deaths
No. of deaths
% occurring
at home
No. of deaths
% occurring
at home
No. of deaths
% occurring
at home
3400
2922
837
1967
2345
1173
1919
2523
30.5
24.6
36.1
31.9
26.1
18.5
15.4
36.1
8216
8424
1153
3279
6275
5933
6311
4974
25.7
21.1
29.1
29.9
24.1
17.9
20.8
25.5
11616
11346
1990
5246
8620
7106
8230
7497
27.1
22.0
32.0
30.7
24.6
18.0
19.5
29.1
1227
507
30.3
29.4
2954
1801
24.7
24.2
4181
2308
26.3
25.4
146
762
3641
935
5387
229
6093
3809
2513
2824
3498
6322
21.2
35.6
32.7
37.0
26.2
38.4
27.4
30.7
23.3
29.9
26.1
27.8
600
1507
8822
2437
3278
563
16077
9529
7111
7470
9170
16640
23.5
26.2
24.7
25.0
23.1
23.6
23.4
24.7
21.6
24.3
22.6
23.4
746
2269
12463
3372
4689
792
22170
13338
9624
10294
12668
22962
23.1
29.4
27.1
28.4
23.9
27.9
24.5
26.4
22.1
25.8
23.6
24.6
a
This analysis excludes those in communal establishments in 1991.
British Journal of Cancer (2004) 91(5), 907 – 912
& 2004 Cancer Research UK
Living arrangements and place of death
E Grundy et al
911
Table 4 Results from logistic regression model of proportion of decedents dying at home (in 5-year period following 1991 Census) from cancer or other
causes by age, gender, type and health status of primary coresident; housing tenure and deprivation level of area of residence
Covariate (in 1991)
60 – 69 years
70 – 79 years
80+ years
Female
Lives with spouse with no long-term illness
Lives with spouse with long-term illness
Lives with other with no long-term illness
Lives with other with long-term illness
Tenant
Carstairs quintile 4 – 5
Other deaths
All deaths
OR
95% CI
OR
95% CI
OR
95% CI
0.90
0.75**
0.56***
0.92
2.53***
2.14***
2.13***
1.37
0.86*
0.89*
0.75 – 1.07
0.63 – 0.90
0.46 – 0.70
0.81 – 1.03
2.15 – 2.97
1.79 – 2.56
1.69 – 2.68
0.90 – 2.08
0.76 – 0.97
0.79 – 1.00
1.07
0.80**
0.55***
0.85***
0.97
1.05
1.16*
1.12
0.87***
0.90**
0.92 – 1.24
0.69 – 0.92
0.47 – 0.64
0.79 – 0.92
0.88 – 1.07
0.94 – 1.17
1.02 – 1.32
0.92 – 1.37
0.81 – 0.94
0.84 – 0.97
0.97
0.75***
0.52***
0.88***
1.28***
1.25***
1.32***
1.17
0.86***
0.90**
0.87 – 1.09
0.67 – 0.83
0.47 – 0.59
0.83 – 0.94
1.18 – 1.39
1.14 – 1.37
1.18 – 1.47
0.98 – 1.40
0.81 – 0.92
0.85 – 0.96
Reference categories: aged 50 – 59 years; male; lives alone; owner occupier; lives in area in top three quintiles of Carstairs score distribution. Po0.05*; Po0.01**; Po0.001***.
95% CI ¼ 95% confidence interval; OR ¼ odds ratio.
and over were only just over half as likely to die at home (OR 0.56,
CI 0.46 – 0.70). Tenants and people living in wards in the two most
deprived quintiles of the Carstairs’ distribution also had lower
odds of a home death than owner occupiers and those living in
more advantaged areas.
It is possible that these results were influenced by variations
between groups in the distribution of types of cancer. However,
when we performed the same analyses for grouped categories of
people dying from cancers with very poor prognosis and those
dying from other cancers, we found no differences between the
two.
DISCUSSION
These results from a large nationally representative study show
that the living arrangements of older people with cancer, and
trends in these, are very similar to those for the rest of the
population. By 1991, over half of female cancer sufferers aged 80
years and over, and a quarter of equivalent men, lived alone.
Although these results indicate a lack of family support available
within the households of many older cancer sufferers, our data do
not allow us to identify familial support from non-coresidents, so
these results should not be interpreted as indicating an overall lack
of family support for older people with cancer. We cannot, for
example, identify cancer sufferers who were supported by relatives
taking it in turns to stay with them overnight, rather than moving
in. Of those cancer sufferers who lived with someone else, their
primary coresident was in most cases a spouse, with much smaller
proportions living with a child, a sibling or another person. In all,
30% of spouse coresidents and 23% of other coresidents had a
limiting long-term illness and 21% of the former and 17% of the
latter were themselves aged 75 years or over. Presence, type and
health status of primary coresident were associated with differentials in the proportions of people dying of cancer who died at
home, but not to the same extent with home death among those
dying of other causes. This difference may be because cancer
deaths are more often anticipated than deaths from other causes so
death at home may be planned, given appropriate support. Older
age and lower socioeconomic status, both individual and area, was
associated with reduced chance of a home death for both cancer
deaths and deaths from other causes.
Data from the 2001 Census have not yet been added into the
ONS LS, but we know from other sources that among people aged
less than 75 years, the proportions living with a spouse increased
reflecting a slight narrowing of sex differentials in mortality and
consequent delay in widowhood (Tomassini et al, 2004). However,
in the population aged 75 years and over – which is rapidly
growing – the trend towards residential independence continued
throughout the 1990s, albeit at a slightly slower rate. As half of all
cancer deaths occur among people aged 75 years and over
(National Statistics, 2001), this implies an increasing challenge to
the delivery of home-based care and more pressure on hospital
beds and other locations, such as hospices, for terminal care.
Indeed our results may partly explain why it is that although most
cancer patients express a wish for a home death, until recently the
proportion of home deaths has been decreasing (Higginson et al,
1998).
The UK health secretary recently voiced a commitment to
ensuring that palliative care is available to all who want it and the
National Health Service has launched a pilot programme to test
various at-home models for terminally ill people (Burke, 2004). It
is important that such initiatives take into account the changing
living arrangements of older people, changes which also have
implications for the quality of life of cancer sufferers.
ACKNOWLEDGEMENTS
This research was funded through a grant made by the Department
of Health Inequalities in Health Research Initiative (Ref. 121/397)
to AS and EG; DM is funded under the ESRC/JISC Census
programme grant to the Centre for Longitudinal Study Information and User Support group (CeLSIUS), Grant Reference H507 25
5179. ONS fund the Longitudinal Study and we are grateful to them
for access to the data. The study was approved by the Longitudinal
Study Research Board.
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Appendix
See Table A1
Table A1
Family/household type (%) of people with no cancer diagnosis in the previous 10 years in 1981 and 1991
Census point and age group
1981 (%)
1991 (%)
50 – 59
60 – 69
70 – 79
80+
50 – 59
60 – 69
70 – 79
80+
Men
Solitary
Couple
Couple+others
Lone parent
Complex
Communal est.a
Allb ( ¼ 100%)
6.9
31.5
48.8
2.5
7.4
1.2
29 670
10.5
56.8
22
1.7
7.3
1.1
24 087
17.6
59.9
9.4
2
8.7
2.5
14 070
27.8
40.5
5.3
3.9
15
7.6
3623
9
35.9
44.2
2.1
6.1
0.6
28 442
13.3
58.1
19.5
1.6
5.8
0.9
24 465
19
62
9
1.7
5.7
2.4
14 961
30.1
46.1
4.4
2.4
7.5
9.2
5128
Women
Solitary
Couple
Couple+others
Lone parent
Complex
Communal est.a
Allb ( ¼ 100%)
9.2
37.3
38
6.7
6.7
0.5
30 425
24.6
47.6
12.3
5.1
9.1
0.9
28 131
44
31.1
3.6
5.4
12.9
2.9
21 463
47.2
9.9
1.4
7.2
20.9
13.3
9564
11.1
42
33
6.6
5.8
0.4
27 705
24.6
51.1
11.4
4.9
6.6
0.8
27 086
45.1
34.9
3.6
4.7
8.1
3.2
21 778
51.9
12.1
1
5.2
11.5
18.1
12 577
a
Some results rounded in order to comply with confidentiality requirements. bIncluding small numbers in categories not shown such as adult children living with parents
British Journal of Cancer (2004) 91(5), 907 – 912
& 2004 Cancer Research UK